Initial Maintenance Therapy Selection for Patients With COPD | Infographics

CHESTGuidelines & Topic CollectionsInitial Maintenance Therapy Selection for Patients With COPD

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Global Initiative for Chronic Obstructive Lung Disease risk groups classified by symptoms and exacerbation history

Group A: Less symptomatic, low risk of future exacerbations
- COPD assessment test (CAT) score <10
- Moderate exacerbation (no hospitalizations)
Group B: More symptomatic, low risk of future exacerbations
- CAT score ≥10
- Moderate exacerbation (no hospitalizations)
Group E: High risk of future exacerbations regardless of symptom burden
- ≥2 moderate exacerbations or ≥1 leading to hospitalization

Pharmacologic management should always be used with nonpharmacologic management

Avoid risk factors
Smoking cessation
Vaccinations
Pulmonary rehabilitation
Oxygen therapy if meets criteria

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Initial pharmacologic treatment

The foundation of therapy for stable symptomatic COPD is inhaled bronchodilators (long-acting beta agonists [LABA] and long-acting muscarinic antagonists [LAMA]).

Group A: Short- or long-acting bronchodilator (LAMA or LABA)

Short-acting bronchodilators (SABD) alone may be appropriate for those with very occasional breathlessness.

Group B: Combination long-acting bronchodilator (LAMA + LABA)

Rescue SABD should be used in all patients for immediate symptom relief.

Group E: Combination LAMA + LABA or combination inhaled corticosteroid + LAMA + LABA if blood eosinophils (≥300 cells/µL)

Rescue SABD should be used in all patients for immediate symptom relief.